Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 18107097 | TN |
NPI | 1073168266 |
---|---|
Provider Name | Mrs. Tresie Menise Lopez |
First Address | Collierville, TN 38017-3718 |
Second Address | Collierville, TN 38017-3718 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2019 |
Last Update Date | 18/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1073168266 | (05) | TN |